Blowing the whistle when things go wrong at work should only be a last resort. Gill Hitchcock looks at the latest guidance and hears how cultural changes can help.
Does your manager listen? Are your opinions taken seriously? If not, then you could be among the 43 per cent of NHS staff who say their organisation does not act on their concerns.
The finding is part of a King’s Fund survey, published this May, which reveals a mixed picture of leadership and compassion in the NHS and prompted the health think tank to conclude that the disconnection between the views of leaders and other staff is a ‘cause for concern’.
Ensuring openness, transparency and candour are among the key recommendations made by Sir Robert Francis in his report on the failings in care at Mid Staffordshire NHS Foundation Trust. But more than a year after his report appeared only 39 per cent of NHS staff feel their organisation is characterised by these qualities, according to the King’s Fund.
High quality care needs everyone to take responsibility for the success of the organisation as a whole. So why aren’t more managers listening? Health policy analyst Roy Lilley gives this explanation in the Guardian: ‘It’s called “managing up”. Passing good news up the line; better no news than bad news, which is never passed up the line.
‘To manage up, you also have to manage down and choke off failure, bad practice and complaints. Hence a corrosive culture of bullying and fear becomes part of an organisation.’
Unions can play a crucial role
This type of culture leaves people with the choice of silence or blowing the whistle, which will typically result in suspension and the end of their career.
‘Whistleblowing is the end of the line. It’s the last resort. We should strive for a situation where whisteblowing is no longer needed because employers have open and transparent workplace cultures that encourage people to raise concerns and that high levels of staff involvement,’ says Claire Sullivan, the CSP’s assistant director of employment relations.
Good employers, she believes, have open cultures, where staff are encouraged to input ideas and try out new ways of working. This type of organisation leaves no need for whistleblowing.
And Sally Gosling, the CSP’s assistant director of practice and development, says that if the Francis recommendations are to be addressed, organisations must join up models of leadership, organisational cultures of learning and transparency, and patient safety.
Dean Royles, the chief executive of NHS Employers, says: ‘Unions know they play a key role in helping to develop a culture where staff feel they can raise concerns and that they will be properly addressed.
‘Staff are the eyes and ears within the workplace and it’s important they’re heard. This will happen mu ch more reliably if their own representatives have confident, supported relationships with employers.’
But he acknowledges that there is still a problem. Staff don’t always have their concerns addressed effectively and then find themselves mistreated when they, rightly, resort to blowing the whistle.
It is ‘vital’, Ms Sullivan emphasises, that whistleblowers are protected from harassment, discrimination or any other disadvantageous treatment as a result or their action.
‘Where people are able to speak to supervisors or managers, do that,’ she says. ‘But obviously CSP members can take advice from their safety rep or steward, who should be the first point of call.’
She has concerns that CSP members employed outside the NHS generally have less protection at work than their NHS counterparts:
‘Our experience is that outside the NHS where people don’t have safety reps and stewards, our members have found themselves in greater need of advice and assistance from us, and we are obviously happy to give it.’
Speaking up charter
In October 2012 the CSP signed up to a national agreement between trade unions and employers intended to encourage a just culture which is open and transparent. The Speaking up charter launched by NHS Employers (see bullet points below), says that a just culture ensures individuals are fully supported to report concerns and safety issues, and are treated fairly, with empathy and consideration, when they have been involved in an incident or have raised a concern.
The society is developing new resources for members to help them raise concerns. They will signpost members to external sources of support and advice on whistleblowing, such as the national Whistleblowing Helpline, a free, confidential and independent advice service for staff in the NHS and adult social care (tel: 08000 724725).
Paul Hodgkin, chair of online forum Patient Opinion, believes that technology empowers whistleblowers: ‘In general, what is happening is that IT is giving everyone a voice, access to infinite amounts of information, and to collaboration tools – even if it’s just Google – to see who else has been affected by bullying or wherever it is. All those things mean it is much easier for people to identify issues which are of concern to them.’
He says whistleblowing is ‘escaping from the bounds of due process’ and that people can use their Facebook page, or set up an anonymous Twitter account, to speak out.
‘So both within the old way of doing things, within due process, there was plenty of scope for organisations to muffle and in the new way there is plenty of scope for citizens to amplify. Both exist and we have to find our way through the new world,’ he says.
In June the Department of Health launched an NHS Choices microsite for patient safety. The intention is to allow staff, patients and regulators to see safety performance across a range of indicators. Key among these is the open and honest reporting of patient safety information.
Mistakes are inevitable
The department has also commissioned Sir Robert Francis to chair a new review into NHS reporting culture to make it easier for NHS staff in England to speak up.
He is expected to recommend measures to ensure NHS staff can raise concerns about any aspect of the quality of care, malpractice or wrongdoing at work and be sure that they will be listened to and that appropriate action will be taken.
In addition, the review will seek to ensure staff will not suffer detrimental treatment as a result of raising concerns and to explore whether there are appropriate remedies so that those who mistreat staff can be held to account.
If this is applied retrospectively, it may help David Drew, who in 2010 was dismissed from his job as a consultant paediatrician at Walsall Manor Hospital after he raised concerns about a colleague who had sent a child home against policy. The boy was then killed at home.
In a foreword to Dr Drew’s book about his shocking experiences, titled Little Stories of Life and Death, doctor, journalist and broadcaster Phil Hammond writes that no matter how much is spent on regulation and risk management, harm – mistakes, incompetence, inhumane treatment and corruption – will always happen.
But the same harm does not need to keep on happening, he argues, because if it is picked up and acted on, many lives and much money can be saved.
Dr Drew says he has told his story for one purpose: to hasten the advent of an NHS culture in which frontline staff are treated with the respect they deserve.
‘This culture already prevails in the best of our hospitals, but in others disrespect, bullying and dishonesty are still the all too common day-to-day experiences of many,’ he says. fl
Speaking up Charter
A commitment by the CSP to:
- share expertise to create ways of breaking down barriers to reporting incidents and concerns early on
- signpost individuals to support and guidance to ensure they understand their protected rights under the Public Interest Disclosure Act
- seek to highlight issues where current law or regulations may restrict people who wish to raise a concern about a human error
- where it is appropriate, exchange information in the interest of patient and public safety foster a culture of openness which supports staff to raise concerns
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